{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINDY HUGHES","gend":1,"add":"342 JACOBS LADDER RD","city":"LEXINGTON","state":"VA","zip":"24450-9998","dob":"1964-05-25","age":"","mstatus":"","insh":"2273714*01","cliId":"","pno":"817\/688-3782","cno":"817\/688-3782","email":"","ename":"","eno":"","pphy":"HARCUS, SINCLAIR J MD","ppno":"540\/463-7628","pcpadd":"108 HOUSTON ST SUITE C","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":24450,"pcpcounty":"","pcpid":186218,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.561","M17.11","M79.604","Z12.31","N63.10","Z85.3","L72.3","Z00.00","K76.0","I89.0","E66.01","Z68.41","Z83.3","G63.","D12.6","K80.20","N20.0","J45.990","C77.3","N60.01","R13.10","Z86.010","C50.812","Z79.810","Z17.0","Z01.419"],"date":["2021-05-14","2021-05-14","2021-05-14","2020-08-19","2020-08-24","2021-06-10","2020-08-24","2021-07-29","2020-08-25","2020-07-27","2020-07-27","2020-08-25","2021-07-29","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-08-24","2020-08-25","2020-08-25","2020-12-10","2021-06-10","2020-12-10","2021-06-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378027493","TAMOXIFEN ","20MG","30","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","30","Select","Select",""],["","45802016000","DICLOFENAC ","1%","100","Select","Select",""],["","57664037718","TRAMADOL ","50MG","30","Select","Select",""],["","16729003516","ANASTROZOLE ","1MG","90","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22","Select","Select",""],["","00574200802","NYSTOP ","100000","-120","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}